The safety and cost-effectiveness of medication therapy for older Americans is less than optimal. We see prevalent adverse drug events (ADEs), polypharmacy, and growing costs for medications for Medicare Part D. To help address these issues, medication therapy management (MTM) services are a mandated component of Medicare Part D. The intent is to use MTM services to prevent and/or readily resolve drug therapy problems by providing additional review of a patient's drug therapy by a pharmacist or other qualified health care professional. However, the quality of MTM services is quite variable. The long-term goal of this research is to improve the safety and cost-effectiveness of medication use by older adults. The objective of this application is to conduct and evaluate a multi-faceted quality improvement program for MTM services provided through a leading MTM service coordinator, Outcomes Pharmaceutical Health Care. We expect to improve the quality of the MTM program in three ways: 1) better targeting of beneficiaries who are likely to benefit from MTM services, 2) enhancing MTM service delivery by pharmacists, and 3) engaging beneficiaries in the medication management process. If successful, this 4-year demonstration project will provide guidance to the Medicare Part D prescription drug plans (PDPs), as well as CMS, for raising the standards of the MTM services delivered to millions of Medicare beneficiaries. For the targeting improvement, pharmacy drug claims data will be analyzed to identify evidence-based risk factors for drug therapy problems (E.g. non-adherence, duplication). Pharmacists will be trained to use a Tool to Improve Medications in the Elderly via Review (TIMER) that will guide them to identify likely problems for older adults during review of their medications. The third quality improvement will be to ask beneficiaries to use the Medication Risk Index (MRI) to self-evaluate their risk for drug therapy problems. Those found at moderate or high risk for a drug therapy problem will be assisted in scheduling an MTM visit, if interested. To track the effects of the QI program, a set of core variables will be calculated from drug and MTM claims data, using a repeated measures approach. These include: nonadherence measures (proportion of days covered, gaps in therapy), use of diabetes medications, use of high risk medications, duplication of therapy, and average monthly drug costs. The repeated measures design will permit comparisons on the MTM performance measures created from drug and MTM claims both within a group over time and across groups during the same time period. For each outcome measure, a generalized linear mixed model will be used to compare the impact of the different quality improvement components (over time and across groups). We believe that this multi-faceted quality improvement program will provide important evidence to guide the further development of MTM services for Medicare Part D beneficiaries.